Mr David Sinclair
Ladies and gentlemen
1. I am pleased to join you for the global launch of the Healthy Ageing and Prevention Index. It is quite clear in my mind looking at this, that this is not an index for competition. I think there is a reason why small countries are ranked amongst the top few countries. The context is different. In a small, especially urban environment, there is more we can do to shape good health outcomes, as opposed to a huge country, where it is a lot more challenging when you have rural areas.
2. The Index is really for self-evaluation and improvement. No country has a monopoly of good ideas and good policy programmes. The Index can provide us with a platform to benchmark best practices, and engage in good discussion on ways to enhance and preserve the health of our people.
3. We know from research findings that about 60% of health is socially determined. It is not determined in the hospitals; it is determined in homes and communities. Yet most countries in the world focus on sick care and not healthcare.
4. Today, I will explain the anomaly, why I think the situation is changing, what governments need to do to further increase the momentum of this change, and what it means for healthcare in the context of Singapore.
5. First, why the anomaly? I think the main reason is that sick care is clear and present, a constant drumbeat and pressure for authorities to respond to immediately. On the other hand, the effects of healthcare, especially in shaping social determinants, is long term. We cannot expect results immediately. Political pressures often forces us to focus on the short term, while the important things with no immediate results fall prey to inertia and procrastination.
6. It therefore follows that the best governance system to enhance health and wellbeing of people, is one that can do what is right for the people for the long-term. That I think in the final analysis will be the benefit and value of this Index. But I think the situation is changing. Why?
7. I am optimistic because governments are focusing on social determinants of wellbeing, for the health of the people. I do not think healthcare will overtake sick care in terms of urgency and emphasis, but I believe the two are gradually ranking equal in importance in the near future.
8. The reason for this change is that the world is ageing rapidly, which makes healthcare a clear and present problem too. The phenomenon that has already taken root in many parts of Europe and Northeast Asia will spread to the US, other parts of Europe, and certainly Asia.
9. For example, it took Singapore only 19 years to transit from an ageing society, where 7% of our population are 65 years and above, to an ageing society where 14% of our population are aged 65 and above. It will take us only another nine years, that is 2026, to become a super-aged society, when 21% of our population is aged 65 and above.
10. In all these countries, people could see the escalation of disease burden on families and healthcare workers. In hospitals, the workload is rising. There is recognition that there is little point in us to keep mopping up the wet floor when the sink is constantly overflowing with water. At some point, you have to stop mopping, and also try to turn off the tap. That is the problem all our hospitals are facing. That means to reduce the prevalence of severe diseases by focusing on preventive care, and to generate health in homes and communities.
11. Next question: what do we need to do? The effort required is not just long term, but also holistic. Education is key, because it gives a person the skills, knowledge and agency to do something about your life. That is to feel useful, to be more wholesome, and to have the ability to contribute and live life with purpose and dignity, which is especially important for seniors. And these are all prerequisites for good health.
12. In Singapore, our education system is known to be of good quality, with a strong emphasis on numeracy, literacy, and values but it is also competitive. The latter is not necessarily unhealthy, but it needs to be calibrated with the changing aspirations and traits of each new generation.
13. Physical living conditions matter a great deal. In Singapore, over 80% of our population live in subsidised public housing, which is of high quality by international standards. Beyond a roof over a family’s head, our public housing provides a sense of security and ownership, a safe haven for children to grow up. Over the years, public housing designs have also moved with the times in keeping up with rising aspirations.
14. In addition, we equip our housing estates with public libraries, sports facilities, parks and gardens, common spaces, eating places, and so on. All of these are not counted in the expenditure of preventive care, but they contribute a great deal to preventive care. Beyond the hardware, we also encourage volunteerism and help social organisations proliferate their services. These efforts help develop supportive communities conducive for healthy living.
15. A third important social determinant is employment. Fortunately, Singapore has a vibrant economy with many opportunities for people, young and old. Our labour force participation rate is high for both men and women. We are gradually raising our retirement age, so people have the right to work longer should they want to, and our retirement age is not linked to the age to withdrawing our retirement savings.
16. There is of course a very important aspect of law and order and good security. We have entrenched the concept of neighbourhood policing and have taken a no-nonsense approach towards crime. Singapore is one of the safest places in the world, which also contributes a great deal to health.
17. So perhaps the area that needs the most work on is healthcare and I think we are not alone in this world. Unlike sick care, which happens in hospitals and clinics, healthcare needs to happen in communities and homes.
18. COVID-19 is a major wake up call to health authorities on the importance of preventive care, to strengthen social determinants of health. The best measures during COVID are preventive in nature, like wearing your mask, observing hygiene, and taking your vaccinations.
19. The Singapore healthcare system post-COVID is therefore undergoing a major transformation. We are building up not just one healthcare system, but three healthcare systems. First, the acute care system, comprising hospitals and clinics, that is well-developed but needs to expand capacity.
20. The second is the preventive care system. Now after many months of planning, we will be rolling out our national healthcare programme called Healthier SG. It is a national preventive care programme. This will be happening in July 2023.
21. Preventive care will be developed through our primary care system of family doctors who will serve as the foundation level of healthcare. Healthier SG will comprise the key components of preventative care implemented in many parts of the world. We rope in private General Practitioners into the national system to leverage dedicated patient-doctor relationships. We have a national enrolment process. We have individualised health plans. We have community support to make social prescription possible. We are fully funding preventive care such as vaccinations as well as health screening.
22. The third system is the aged care system. Nursing homes and aged care facilities are always necessary, but they cannot be the mainstream and the default arrangement for the aged.
23. We are building up social support to enable the majority of our seniors to age actively in communities. Our family units are getting smaller, and our seniors are increasingly at risk of becoming isolated. We therefore need to vigorously combat the challenge of deteriorating health due to social isolation.
24. Building up a community-based aged care system requires tremendous social activation of volunteers and social welfare organisations. We are establishing a network of several hundred Active Ageing Centres to serve as focal points of such social interventions. They are also physical premises for seniors to form social groupings.
25. The advancement of age and the demographic march is inexorable and irreversible, but ageing and the deterioration of health are not necessarily a given. With good policies and improvement of our care systems, we can slow down ageing and even reverse frailty in many instances. And if we can preserve and enhance health, 65 need not be that magic number where we somehow are regarded as aged and we fall on the wrong side of the dependency ratio.
26. Our mission is to raise that magic number 65 to 70 or 75 and we can be healthy and continue to contribute to society and take care of others way beyond age 65. We can narrow the distance between our healthy lifespan and our biological lifespan, and we can redefine ageing.
27. Singapore is committed to making this challenging but important transformation of our healthcare system into the three systems I mentioned earlier. As other countries confront their own demographic challenges, they will also need to undertake similar journeys and an Index like this is a very useful tool at this time of history and serves as a compass for governments to track our progress of preventive health and ageing, to monitor and evaluate if we are indeed achieving outcomes. Thank you and all the best.